Effect of ischemic time on survival after heart transplantation / 中华器官移植杂志

ABSTRACT

Objective Given the significant differences of ischemia-time tolerance observed in clinical heart transplantation between heart and other solid organs,it is important to make a clinical assessment of the correlation between the cold ischemic time of the donor heart and the survival rate after heart transplantation.With these results,we may standardize the management of clinical heart transplantation by providing a proper heart cold ischemic time frame for reference.Method The clinical data of 131 orthotopic heart transplantation patients in our hospital,from September 2008 to March 2014,were collected and analyzed retrospectively.All donor hearts were preserved in histidinetryptophan-ketoglutarate solution (HTK solution) during cold ischemic time.The cold ischemia time was 103-485 min,with an average of 245.2 ± 120.4 min.According to the cold ischemic time,all patients were divided into three groups＜ 3 h (n =62); 3-6 h (n =41); ＞6 h (n =28).Result (1) Prolonged cold ischemia time could result in high IABP usage perioperatively (postoperative IABP support rate for the three groups was 3.2％,9.8％ and 14.3％ respectively,P =0.155) and high rejection rate (incidence of rejection was 6.4％,9.8％ and 17.9％ respectively,P =0.245),but there was no statistically significant difference.(2) Three weeks after the transplantation,all EF values of the three groups were reduced within the normal range,with no significant difference.Perioperative overall survival rate was 97.7％ (128/131),while survival rate of the three groups was 97.29％ (72/74),100％ (30/30) and 96.29％ (26/27),respectively (P =0.61).(3) One-year overall survival rate was 89.87％ (71/79),and the one-year survival rate of three groups was 92.2％ (47/51),90.9％ (10/11) and 82.4％ (14/17) respectively (P=0.51).Fifty-two patients were still under 1 year follow-up period.This study aimed to illustrate the effect of different cold ischemic time on perioperative cardiac function,rejection rate,IABP usage postoperatively (intra-aortic balloon pump or intra-aortic balloon counterppulsation) and early/mid-term efficacy after transplantation.Conclusion Cold ischemic time within 6-8 h is clinically safe for heart transplantation,and can provide satisfactory early and medium-term effect.Donor heart with cold ischemia time longer than 6 h may extend the recipient inclusion criteria.But considering the safety of transplantation,these donor hearts may be more applicable for the marginal recipients.This study describes the relationship between cold ischemic time and early and medium-term effect of heart transplantation.However,its long-term effects still require further investigation.